Provider Demographics
NPI:1093975195
Name:LIEBERMAN, SUSAN LINDA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LINDA
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3312
Mailing Address - Country:US
Mailing Address - Phone:561-866-3956
Mailing Address - Fax:561-241-1631
Practice Address - Street 1:3250 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3312
Practice Address - Country:US
Practice Address - Phone:561-866-3956
Practice Address - Fax:561-241-1631
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist